The NHS is losing specialist staff in ADHD and autism services to private clinics, forcing trusts to restrict patient access and deepening inequalities in care.
Psychologists, psychiatrists and nurses are leaving NHS neurodevelopmental services for the private sector, where they can see patients more quickly and often earn more. Herefordshire and Worcestershire NHS trust restricted access to its service to only the most urgent cases last month because staffing levels had fallen significantly, with most departing staff moving to independent sector or Right to Choose providers. The trust will return to normal access on Monday. About 1,298 people have waited at least two years for an ADHD or autism assessment at the trust.
Roughly 810,000 children and adults in England currently wait for an assessment. The surge in demand for ADHD and autism diagnoses has overwhelmed NHS services, creating backlogs that have allowed scores of private clinics to expand in recent years. The Care Quality Commission announced Friday it will begin inspecting private clinics offering diagnostic assessments, which are currently unregulated, after the government-commissioned review by Prof Peter Fonagy urged tighter regulation of all service providers.
Adrian James, the CQC's interim mental health inspector, said the new oversight will "close a significant gap" and give people "far greater confidence" in their diagnoses. Yvette Cooper, the health secretary, said regulation ensures "assessments are high quality and that the NHS is not being overcharged by independent or private providers."
Thea Stein, chief executive of the Nuffield Trust, warned that the exodus weakens the NHS and widens inequalities. She said some staff work part-time for both sectors, but many "walk away entirely." If NHS services cannot retain fully staffed teams to meet demand, people who can afford private care will receive faster diagnoses while others face longer waits.
The NHS Alliance, representing trusts, confirmed staff continue to leave. Rebecca Gray, director of the alliance's mental health network, said the private sector's faster service times make independent employment attractive to staff already under pressure in stretched NHS services.
The Independent Healthcare Providers Network, a trade body for non-NHS firms, welcomed the CQC's expanded role. Sean Phillips, its head of policy, said IHPN members delivering ADHD and autism assessments are already CQC registered, with 83% rated good or outstanding.